Evidence Flashcards
evidence
data from clinical research performed on patients
theory
data from basic science research or observation
ex. US will facilitate healing process-no great evidence
evidence hierarchy-intervention
systematic review of RCT
single randomized trial
systematic review of observational studies with pt-important outcomes
single observational studies with patent-important outcomes
physiologic studies
unsystematic clinical observations
Systematic review
advantages- combines data from diff individual studies. Provides consensus.
disadvantages- Need high quality individ studies though
Meta analysis also combines data from the studies
Randomized clinical trials
provides definitive results and reduces influence of bias
disadvantage is making inferences from a group of pts to an individual
Observational studies
less expensive and can detect low rate occurences
treatment effect often inflated and influence of bias is inevitable. No control
physiologic studies
provide underlying mechanisms
lack clinical meaning
unsystematic clinical observations
good starting point and generate hypotheses or theories
limited scope
Critical appraisal of evidence questions
- study valid? (therapy checklist–randomization, follow up, intention to tx, blinding, baseline)
- results important? (significance, magnitude)
- results applicable to our patient?
evidence pyramid
systematic reviews
RCT
cohort studies
case-control studies
case series
case studies
textbooks, expert opinion, narrative reviews
PICO
Patient/Problem/Population-most imp characteristics of the pt
Intervention-describe the main intervention
Comparison-describe the main alternative being considered (ex placebo, no tx, gold standard, etc)
Outcome-what trying to accomplish, measure, improve, affect
-asking a good research question should include the four parts
Patient problem or population
first step in developing a well built question…
describe either the pt chief complaint of generalize the pts condition to a larger population
Intervention
identifying the intervention is the second step in the PICO process
important to identify what you plan to do for the patient
Comparison
the third phase of the well-built question, which is the main alternative you are considering
Outcome
the final aspect of the PICO question.
specifies the results of what you plan to accomplish, improve or affect and should be measurable.
